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"The abnormality or disease of ihe small intestine may cause chronic diarrhea. The tests required to investigate the abnormality of the small intestine are difficult and expensive. In this study we studied the small intestine in chronic diarrhea cases, to discover any abnormality.The chronic diarrhea patients presenting from 1996 to 2000(5 years) at Cipto Mangunkusumo General Central National Hospital were included in the study. Patients were excluded if unable to co-operate. All of the patients were given blood and stool lexis in addition to colonoscopy, ileoscopy and duodeno-jejunoscopy with biopsy.Small intestinal examination could only be performed on 78patients witii chronic diarrhea. The most frequent characteristic were: aged 30-39 or 50-59 years (25.6% of all canes in the study), male(57.7%), non-bloody non steatorrhoeic tvpe of diarrhea(74.4%), and 4 to 48 weeks-duration of diarrhea(68.0%). Small intestine abnormalities were endoscopically and/or histopathologically found in 65 cases(S2.6%), while the rest of the patients were found to have normal small intestine. The abnormalities were found to he infective non-tuberculosis ileitis (in 20 patients, or 26% of all cases), Infective non-tuberculosis duodenitis(20 or 26%), non-infective jejtinitixf 14, or 18.2%), villous aft phy of the jejunum(3, or 3.9%), lymphoid nodular/follii hyperplasia of the terminal Heutn(l2, or 15.6%) etc. LOT intestinal abnormalities were found in 67 or S3.7% of t chronic diarrhea cases.The frequent small intestinal abnormalities were infe tive ileitis, duodenitis and lymphoid nodular/follicle hype plasiaofthe terminal ileum. The small intestinal abnormal ties were found less than the large intestinal abnormalitie"

"Background: Chronic diarrhea is common in Indonesia. The chronic non-infective diarrhea cases seem to be increasing recently. The aim of this study is to reveal the pattern of diseases that can cause chronic non-infective diarrhea.Materials & Methods: We examined all patients suffering from chronic non-infective diarrhea over a six years period. The patients underwent physical examination and performed laboratory tests, colon enema X-ray, colonoscopy, ileoscopy, upper gastrointestnal endoscopy and small bowel X-ray.Result: Chronic non-infective diarrhea was observed in 107 (51.7%) cases from 207 chronic diarrhea cases respectively. The frequently found abnormalities that had caused chronic non-infective diarrhea were carbohydrate maldigestion (62.61%), colorectal cancer (14.01%), Crohn's disease (11.21%), ulcerative colitis (9.34%), irritable bowel syndrome (8.41%), colorectal polyp (8.41%) etc.Conclusion: The most frequent abnormality found in chronic non-infective diarrhea was maldigestion."

"Insidens diare kronik di Asia berkisar antara 0,8 ? 1,0%. Lokasi penyakit dan kelainan yang menimbulkan diare kronik dapat dibagi atas 3 kelompok yaitu usus halus, usus besar dan ekstra intestinal. Penyakit-penyakit pada usus halus terdiri dari infeksi dan non-infeksi. Penyakit-penyakit infeksi antara lain yaitu infeksi bakterial, infeksi parasit dll. Penyakit-penyakit non-infeksi yang menimbulkan diare kronik a.l. penyakit Crohn, ?Celiac sprue?, enteropati OAINS, intoleransi laktose, tumor jinak, tumor karsinoid, karsinoma, komplikasi pasca bedah, obat laksatif dll. Pendekatan diagnosis terdiri dari anamnesis riwayat penyakit yang baik, pemeriksaan fisik yang teliti, laboratorium penunjang, laboratorium penunjang yang lebih spesifik termasuk foto rontgen kolon, foto rontgen ?esofagogastroduodenum follow-through?, ?enteroclysis?, pemeriksaan ileo-kolonoskopi dan endoskopi saluran cerna atas termasuk usus halus dengan biopsi untuk pemeriksaan histopatologi. Pengobatan diare kronik dibagi atas pengobatan suportif dan kausal. (Med J Indones 2002; 11: 179-89)

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The incidence of chronic diarrhea in Asia is between 0.8 ? 1.0%. The diseases and abnormalities according to the location, which can cause chronic diarrhea, are divided into three locations: the small bowel, the large bowel and extraintestinal. The small bowel diseases include infectious and non-infectious diseases. The infectious diseases are bacterial infections, parasitic infections etc. The non-infectious diseases include of Crohn?s disease, Celiac sprue, NSAID enteropathy, lactose intolerance, benign tumor, carcinoid tumor, carcinoma, post surgery complications, laxative etc. The approaches to diagnosis include good anamnesis, careful physical examination, supporting laboratory tests, more specialized supporting examinations including X-ray of the colon, esophagogastroduodenum follow-through, enteroclysis, ileo-colonoscopy and endoscopy on the upper portion of the digestive tract including the small intestine with biopsy for histopathology examinations. The treatment for chronic diarrhea is divided into supportive and causal therapy. (Med J Indones 2002; 11: 179-89)"

"Background: The incidence of chronic non-infectious diarrhea cases is increasing in line with the developments of medical technology and science. The objective of this study was to uncover the histopathologic abnormalities of the small bowel in cases of chronic non-infectious diarrhea. Materials and Methods: All chronic non-infectious diarrhea patients in Cipto Mangunkusumo Hospital from 1996 until 2000 were included in this study. For the control group, we used 37 endoscopically-normal patients with junctional dyspepia with the some characteristics (sex and age). All of the patients underwent gastroduodeno-jejunoscopic and ileocolonoscopic examinations. Patients with infection were excluded from this study. Biopsies were taken from the duodenal bulb, descending duodenum, jejenum near the Treitz ligament, terminal ileum, and colon. Histopathological tests were performed on all of the biopsies. Result: Histopathological examination was carried out on 31 patients and 37 control patients. In the duodenal bulb, the width of villi, lymphocyte infiltration, cosinophil infiltration, stage of inflammation, and polymorphonuclear cells infiltration were all lower in the chronic non-infectious diarrhea group than in the control group (p< 0.0l). ln the descending part of duodenum and jejunum, lymphocyte infiltration, the stage of inflammation, and polymorphonuclear cell infiltration were found to be higher in the chronic non-infectious diarrhea group than in the control group (p< 0.01). Within the terminal ileum, lymphocyte infiltration, the stage of inflammation and lymphoid follicle hyperlasia were found to be higher in the chronic non-infectious diarrhea group than in the control group (p< 0.01). Conclusion: Histopathologically, increased lymphocyte infiltration, inflammation and lymphoid follicle hyperplasia were discovered in specified areas of small intestine in chronic non-infectious diarrhea patients."

"Kolitis adalah salah satu penyakit saluran cerna yang sering dijumpai di Indonesia. Peptida antimikroba human beta-defensin 2 (hBD-2) merupakan bagian dari komponen sistem imun alamiah sistem gastrointestinal yang diteliti perannya dalam patofisiologi kolitis. Penelitian ini bertujuan memperoleh kadar hBD-2 feses pada pasien kolitis di RSUPN dr. Cipto Mangunkusumo, serta apakah terdapat perbedaan kadarnya pada kolitis infeksi dan non-infeksi. Penelitian potong lintang ini dilakukan pada subjek kolitis yang direkrut secara konsekutif di poliklinik Gastroenterologi dan Pusat Endoskopi Saluran Cerna RSUPN dr. Cipto Mangunkusumo, pada bulan Juni – Oktober 2020. Sampel feses dari subjek diperiksakan kadar hBD-2 dengan metode ELISA, feses rutin, darah samar, serta biakan di Laboratorium Departemen Patologi Klinik RSUPN dr. Cipto Mangunkusumo. Kadar hBD-2 feses subjek kolitis infeksi dibandingkan dengan kadar hBD-2 feses subjek kolitis non-infeksi. Diperoleh 26 subjek kolitis infeksi dan 20 subjek kolitis non-infeksi dengan median kadar hBD-2 feses berturut-turut adalah 40,39 (5,11 – 555,27) ng/ml dan 36,35 (1,75 – 260,34) ng/ml. Terdapat kecenderungan kadar hBD-2 feses yang tinggi pada subjek kolitis tuberkulosis dan kolitis jamur dengan median berturut-turut 460,55 (30,94 – 555,27) ng/ml dan 340,45 (283,01 – 361,95) ng/ml. Tidak terdapat perbedaan kadar hBD-2 feses yang bermakna antara kolitis infeksi dan non-infeksi (p > 0,05). Perlu dilakukan penelitian lanjutan dengan jumlah subjek lebih banyak untuk kelompok kolitis tuberkulosis dan kolitis jamur.

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Colitis is one of the most common gastrointestinal diseases in Indonesia. Antimicrobial peptide human beta-defensin 2 (hBD-2) is a part of gastrointestinal innate immunity which roles in the pathophysiology of colitis are still being studied. This study aims to determine fecal hBD-2 concentration in colitis at RSUPN dr. Cipto Mangunkusumo, and whether there is significant difference of its concentration in infective and non-infective colitis. A cross-sectional study was conducted on colitis subjects recruited consecutively at Gastroenterology Clinic and Gastroenterology Endoscopy Center of RSUPN dr. Cipto Mangunkusumo, in June - October 2020. Stool samples collected were tested for hBD-2 concentration using ELISA method, routine fecal analysis, fecal occult blood test, and culture at Clinical Pathology Laboratory of RSUPN dr. Cipto Mangunkusumo. Fecal hBD-2 concentration was compared between infective and non-infective colitis. There were 26 subjects with infective colitis and 20 subjects with non-infective colitis. Fecal hBD-2 concentrations of the two groups were 40,39 (5,11 – 555,27) ng/ml and 36,35 (1,75 – 260,34) ng/ml. Fecal hBD-2 concentrations in tuberculous colitis and fungal colitis tended to be high, 460,55 (30,94 – 555,27) ng/ml and 340,45 (283,01 – 361,95) ng/ml. There was no significant difference of fecal hBD-2 concentrations in infective and non-infective colitis (p > 0,05). It is recommended to conduct further study with more subjects regarding group tuberculous colitis and fungal colitis."

"We describe that often colonic tuberculosis remains unsuspected prior to surgery. We therefore draw attention to pitfalls in the diagnosis and review the literature on the diagnostic modalities available to diag-nose the disease. Today, the prompt diagnosis of an unknown gastroenteritis process invoives colonoscopy.

Using a fiberscope, a procedure with instantaneous return can be carried out. Patients with clinical presen-tation suggestive of coionic tuberculosis should have had either an aggressive diagnostic work out using high-yield tests or anti tubercuiosis therapy."

"Background: The diagnosis and treatment of chronic diarrhea is sometimes difficult. Orocaecal transit time may explained some pathogenesis mechanism in chronic diarrhea.Materials & Methods: Twenty six chronic diarrhea patients and 35 normal adult subjects were included in this study. After fasting for at least 10 hours, subjects were asked to drink 20 ml (13.3 g) lactulose, then performed the breath hydrogen test. If there were an increment of H2 concentration 10 ppm in '/2 -1 hour, the subject was considered as rapid transit time, ff an increment of H2 concentration 10 ppm in 1 - 2 hour, the subject was considered as normal transit time. If an increment of H2 concentration 10 ppm in 2 - 3 hour,the subject was considered as delayed transit timeResults: In the chronic diarrhea group, 10 (38.4%) had rapid OCTT, 15 (57.6%) had normal OCTT and only 1 (4%) had delayed OCTT. In the normal adults group, 2 (5.7%) had rapid OCTT, 22 (62.9%) had normal OCTT and 11 (31.4%) had delayed OCTT. The difference was statistically significant (p < 0.001). The mean value of OCTT in chronic diarrhea and normal adults were 84.23 ± 39.82 min vs. 114.00 ± 51.35 min (p = 0.027).Conclusions: The rapid OCTT was more likely to be found in the chronic diarrhea patients compare to normal adults significantly. The mean OCTT in chronic diarrhea was shorter than the mean OCTT in normal adults."